milli million. on page 10 of the report, advices that one operator training class was cancelled in the 2015, and that all of the remaining 13 classes in 2015, had to be reschedule or adjusted to fit the training facilities that were available. and when the operating training classes must be pushed to saturdays, the sfmta estimates that this costs sfmta, approximately, 26,000 in over time, and reports that this occurred, 3 times in 2015, and anticipated to occur at least

once in 2016. sfmta response notes that the sfm training staff, shortages, not lack of facilities resulted in additional operator, over time, costs, of $920,000 in 2015, 6.9 in 14, and 13 and 12, and notes that if, if, sfmta were to have missed just one training class with 30 bus operators and based on the existing attrition rate of the 50 operators per month, they would have to misschedule muni service or in crease, operator over time. if one training class of 40 bus operators, cannot be reschedule, sfmta estimate tz would result in more than 400,000 in over time or $5 million of additional

over time cost to sfmta. on the bottom of page 10, supervisors, we note that the sfmta, will spend $2 million for the costs in the first year, which is 575 percent more than the 375,000 incurred in 2015, but the training facilities in the related expenses. over all, sfmta will expend, 24.5 million in rent, over the 9 year term, and at the end of that period, if the city of san francisco does not extend the agreement with the owner on the property to allow a bus operator training facility on this sight, they will find itself in the same situation it as it is, and there will be fewer lease or purpose options at that time, simply, if the sfmta exercises the options to purchase the

site, they would expend it minimum of 44.4 million, or 5 million, 44.5 million. including the rental costs and the costs in the property with no guarantee that the site will be used as a long training bus operating facility, that the city may require a different use of the property. supervisors, on the powerpoint presentation the department says that the average daily service missed and they show, and i want to emphasize that they have not represented that this is because of the training facilities, this is because they missed services as you know because operators maybe sick and call in sick. but because buses are down,

because of a lack of maintenance. i also want to note that i, first of all, i appreciate mr. haily's forth right respond to supervisor yee's question. and that he specifically said that there was not one class, not one classes that been cancelled because of a lack of facilities. and i appreciate that honest response. mr. chairman, members of the committee in conclusion, we are not questioning the desirability of one consolidated training facility. our question is the significant cost increase and the fact that as supervisor tang has pointed out, at the end of 9 and a half years, the sfmta may be back to

square one. our recommendation is we recommend that you amend the pro-he posed resolution to 9 years and five months. as stated in the lease. instead of the 9 years and 6 months as stated in the resolution. and we can consider approval of the proposed resolution as amended to be the policy decision for the board of supervisors and we would be happy to respond to any questions. >> okay. >> thank you mr. rose. colleagues any questions right now for the budget analyst? >> okay. why don't we open this up to public comment. item four? anybody wish to speak on item four? or sing on item four? >> ♪

>> thank you, anyone else wish to comment on four? >> seeing none, public comment is closed. >> colleagues, i will open up for anyone's comments, or discussions or motions. i struggle and have struggled with one, i understand the necessity, here and i think that the cost and some of the

questions were spot on and our budget analyst report. i think that we have a number of options here. but let's have a dialogue here, supervisor tang? >> thank you. >> so again, this is not an easy one here, but i think that what i would be comfortable with is sending this out without recommendation to the full board and maybe when it is in front of all eleven colleagues, then, perhaps there could be more discussion on it. more questions answered from some of them that may wonder about this cost as well. but just at least move it along forward and see if you know i don't want us to talk in circles or if there is anything that can be productive and make sure that mta reaches out to all of the supervisors before it gets to the full board. >> okay supervisor yee. >> thank you tang for that position. >> i don't want to hold it up. i am not comfortable, fully support it today. but at the same time i

understand that we need to continue this progress on the lease and bring it to the full board and see there is enough support or whether or not at that point may find a better arguments on why i should be supporting it. i will support, or second it. >> okay. >> and let me just suggest that we will go out to the full board without recommendation in the interim, if i would asked to be at every, supervisor office talk and briefing with them to have a vibrant discussion of the full board and informed and that, as much as possible, staff comes to the full board meeting when we consider it as well. >> okay, motion by supervisor tang, then, and we can take it without objection. >> mr. chairman, would you like to take any action regarding the proposed amendment? >> right, sorry, the motion to vote. >> i amend my motion to accept the budget analyst. >> rescind the vote. >> by supervisor tang and take that without objection.

>> and now i make the motion to amend it with the budget, and send it forward without recommendation for the full board. >> tang and now we can take that without objection. >> okay. thanks, everyone, for that item. we have item number five here, there clerk would you call 5. >> ordinance providing that the competitive solicitation process requirement in the administrative code, 21.1, shall not apply to the department of public health's contract for a modern, secure and fully integrated electronic health record system for the san francisco health network to replace, dph current system and the selection of the reintelligents of the university of california. through the university of california, san francisco. as the preferred contractor and authorizing dph director into negotiations with uc to procure the new ehr system, or enter into negotiations with specified

alternate vendors as defined in this ordinance. if negotiations with the uc are unyou can is s unkuk seg /* /- unsuccessful. >> could we hold on for 15 seconds. >> all right, everybody welcome back from -- okay, everybody, welcome back, >> good morning, director of health and just to state that there are three additional staff members that will be addressing our request today. and as you know we are seeking authority for the next step of our procurement for the

electronic health record. the federal government is looking at this and it is important that you will hear about the safety of patients and also about insuring that our physicians also, accept the system that we create and purchase. we have 60, cares, and it works in the adequate systems and so acquiring the unified, electronic system is the top priority for dph in. and not to say that for the five years that i have been health director the majority has been focused on the it system. we were not prepared four years a ago, and we have a lot for the infrastructure and to be ready

for an integrated electronic health record. and the eehr systems as we call those are improve, for the patient's care and safety, you will hear today with 61 distinct systems of applications how can you really serve a person as they are going through the integrated system. it improves the data and research for the better health outcomes and the federal government is not looking at the number of people that we are serving as we used to be funded for, and they are really looking at how well are they doing after your care? and the out comes that we, are trying to reach, as provided by the federal government. and we are also seeing that with the integrated with the electronic health records that we improved the revenues by a great percentage and we reduce the compliance risk when we know where everyone is in one system, so this is a very costly system for us. and so we really only have one opportunity, at this opportunity. that we are looking to do today. and so, it is really important

for us to get this right. and every patient, that is impacted by this, as well as every social worker and every nurse and every physician in terms of providing care, at dph. we have worked at looking at two distinct options, for the approach for unified electronic health record, there are and we do have a great opportunity, unique opportunity, and a partnership to share the use of the existing system at the university of california san francisco. or we could do a selective event to directly build a new system. and we have determined that ucsf is our best opportunity for a unified, electronic health record and half of the physicians are already on the uc system. and the apex as they call it and part of every research, that you would look at for failed, implementations of these systems are dependent on the ability for the users to really adapt and

accept an electronic health record and we believe that using the medical center and the system and bringing that together with dph who has already had seven implementations of this unified, electronic record puts us in a strong are position for the future of our ability to adapt and implement this new system. so today we are looking for permission from the board of supervisors to negotiate with ucsf to contract, for its share to unified electronic health record. we have one of our leaders in the clinical system and cfo will be making presentations today to the importance of this seeking authority from you. >> thank you. >> and just as i quick question, to confirm, and in my role in the hsf board and a lot of

supervisors are spending a great sums updating the systems and this is, and i guess that i am asking you, this is a major push kind of threw out the hospital systems and services systems. >> absolutely, we are on the late train on this. because all of the other systems in our area have already made the decision like this and we are one of the last systems to not have the health record and that is because we are trying to build the network and trying to find the financial pathway for this as well and so important for us to do this as soon as possible and so that we can compete and meet the obligations and we bring in $600 million of revenue, every year, if you look at that from a 5-year, period of time, that $3 billion of revenue that is dependent on the electronic health record. >> i will be introducing albert who is our director of

ambulatory care. >> good afternoon, i am a trained physician, and director of the care and the chief, officer for the health department. you may know this already, san francisco health network is actually dph integrated delivery system in 2013, it is the only complete system in the city, it has an acute hospital, and it long term care facility, and a primary network of mental health and substance abuse clinics throughout the city, and researches, including, the public health nurse and our trial and analyst, and health program and the nurses and the health at home, who serve, mostly home bond, san franciscans. so this is the problem, the problem is, as an example, when i am seeing my patient, mr. lee, who is actually a patient of mine, and where i see the patients i don't have access to all of his clinical information across the multitude of the systems out in our network.

that really presents the significant risks that i could either prescribe a medication, that interacts with another drug that was prescribed by another in the network or missed a diagnosis that was picked up by another provider. or that i missed an abnormal findings that were ordered outside of the primary care network. or failed to follow up on something. so there is significant patient safety risks when the entire set of that patient's information is not available at the point when i am seeing my patient or any of the provider frankly. >> could i ask you a question on that? >> please. >> i fully understand that. my point of view with my children and my parents. and medical situations, certainly in the last few years, that being said, why can't you? with the two different systems what prevents from having a second terminal. and two screens up at once. >> yeah. so, well, certainly it is about

accessing so some of is certain systems are not accessible to me because i don't interact in the mental health system even if i do have access to that, i am not sure if i know how to navigate through a very complex electronic health record system where the filing of the information and the storage and the information the documentation of the content may be structured in a way that i will not be easily to decipher, that is one. and second, the different electronic systems require an enter face and very technical mapping of information and sharing of information. and as director garcia noted, and bill later will talk about more, we have been spending a lot of effort over the number of years to try to show up the infrastructure to leverage in technology, if you don't have it in place you will not able to use this. those are probably the biggest driver and the third one is over in the last two or three decades, and the network and the

department, has really, sort of adopted, patch word solutions to meet the needs of san franciscos and the population that we serve and so we have not approached it in a coordinated unified manner to say let's have one solution regardless of where that patient is, and which provider is, and which part of our system we are seeing all of the information, and real time, and in accessible. >> so we can do that right now. so what we can, and what we cannot do is see the entire picture at any point in terms of the access to the system. so these, and these are just examples on left side. the director garcia mentioned the 61 systems and touching the different part of the network.

so what is an ehr. simply it is a digital record of the patient's information not on paper format. and it provides real time, patient centered record where all of the information is available, securely, and instantly when you need to access it. and it includes the medical problem, the medication list, the diagnosis that is made and the labs and the studies and all of the notes and that is all in one, repository i want to give you a story, this was a patient that i saw last night. he was referred to me as a behaviorist and a psychiatrist, and one of the mental health clinics in the network and the two there, and recognized that he had a he did not have patient a relationship with any of the primary care physician, and so that was referred to me as a

mare care doctor and he had a new condition that warranted more evaluation. so when i saw the gentleman, the only thing that i knew, was, what was recorded in the chief complaint because he did not bring any records and he did not bring his medication bottles when was recorded when the appointment schedule was referral, to established care. so, i inquire you know, how can i help you tonight? and what is, what brought you to the health center? and he said, in a matter of factually, don't you have that information? i just saw the therapist and the psychiatrist the other day and he referred me to you and he said that you will know what to do for me. >> i was a little bit embarrassed because i didn't have an answer to the question because i did not have access. so i tried to do my best, that night get the information and perform evaluation and i asked to make sure to get the records

and ask them to staff the records over. when i reviewed the records and was alarmed that he was recently seen at saint francis and was prescribed a medication that if it was not tie traited well, it could actually lead to very serious, and potential, fatal complications. i toemd my medic aexistent.

now there is a dual process, involving for the two systems to bill for the services. i document my assess m, in one system. and but we bill, for the services out of another electronic, health ehr system. we have some of the information is automated and enter face as you sort of ask, on the chair, farrell and some of the data is enter faced and some of it requires the manual entry, and as you can imagine, that really, processes the potentially not billing for all of the processes or billing for what we did not enter, or enter it wrong, and so therefore it puts us at a risk. and not to mention, all of the new funding requirements on the out come not just the service from the government. so, why do you ucsf? >> it is really a unique partner to help us to better service the patient and they are not just a

vend vendor. they already built, and designed and implemented and the system in across the hospitals in the network. and over has and there is failures and success that you learn from those experiences. we have had 150 a year, partnership, with really, the institution that shared very similar, mission. and that is to provide, quality and compassionate care, to the most vulnerable, citizens and residents of san francisco. we know from the industry, and from partner, an industry expert in hit, as well as from our prior electronic health record implementation. that the number one biggest driver of success or failure, is physician adoption of that information system. it is not just about efficiency,

but it is also cost control. and because all of the physicians and trainings are from ucsf, their knowledge and proficiency, using epic or as they call it apex will be incredibly valuable to us, having more likelihood to succeed in our implementation, and more importantly, there is an opportunity, cost there. which is because they and because the inpatient system, and they are very familiar with. and we can spend our time and re soe resource building out the other mod youals, and the mental health records and the job health records and the tr transitional records. we will be able to take that resource and start building the other pieces sooner, and faster, so that we don't delay, this coordinated fragmentation, of

information. and 78 percent, of all of the patient rerefer, outside of bph goes to ucsf for the services that we don't currently render in the network, that is, you know, that sharing the same instance, actually makes it seamless, because they have the same record when they go up there and simply when they come back to see me, i will know exactly what they did, when that patient returns. and issue, and there is no issue. and obviously throughout the bay area, the majority and i would say that the majority of the bay area, health systems are already on epic and it gives us the information to share the information and exchange data cross the systems to learn at a population level, how do identify the needs and the gaps of the vulnerable population and how to create the service to better serve them. and lastly, both organizations are committed to the local business enterprising and training opportunities to increase a diverse workforce.

at this point, i am going to transition to bill. >> good morning. i would like to give you a background on how we got here today. so, as you may be aware, last year, dph submitted, to dpehr replacement project. it was a very high level, estimate. one thing that i do want to know, unlike most struggled ehr effort, this effort is actually not an it initiative, but one of business. so if you go back several years, dph, focused on improving dph effectiveness to better protect, health of san francisco in a post, high-tech, world. engaged several experts in the field and not only in healthcare but also in it.

now, what came out of that was, that they needed to improve the capabilities in order to better super dph so that it will provide better support and care for san franciscans, and specifically this meant that it capabilities had to be improved, in people, process and tools. so, we have in the last two years, hired 71 positions, and we continue to hire more. these people will be, these are city employees who will be not only be supporting ongoing operational functions, but also free up, the exist an subject, matter experts to help us build a new system. now, in addition to that, we have implemented a new it,

industry level, and best practices and framework for the it process. the reason why, i bring these two up, is because, in order for any ehr effort which are in a large dollar amount to be successful, you have to have the foundation to succeed. in terms of the infrastructure, with the help of our local businesses, and obs, we are now implementing that medical grade fully, functioning high capacity high performance, insfra structure across dph throughout san francisco and we expect to that have in place, before the go live of this ehr. that brings us to the last piece. the last piece that we are here to talk about which is the ehr. our foundations are finally getting there. we now need the tools to do this. and now, the reason why i am here, is to actually echo what actually has been and learned by

many of the organizations which is that you can spend hundreds of millions of dollars and still fail, if, you fail to actually use the system. what happens typically and the failed implementation is not the technical aspect and i hear as a cio will tell you that it is actually pretty simple. what is hard, is reworking the processes. and understanding what needs to be done and who does it. training your physicians, and the nurses, and everyone to use the system effectively. and this will not only have an impact on our budget, and the over all project budget, but it will also have the patient safety impact, but more importantly, this will have revenue impact. you could look, at many articles on the internet these days about failed implementations and they will tell you, the implementation was great. but because they could not use it, they are not receiving the money that they were seeing

prior to the implementation. >> i believe because the physicians are using the system that we are proposing to contract it, and that we will mitigate, the most significant risk to the largest indid he ever that we are taking in the city. and now, interesting enough, after all of the discussions and all of the explorations that we did, we actually came to the same place that the federal department of health and human services and industry, analysts showed only two leading ehrs and it is true that there are two that could help us, but i have to really, focus, on the fact that we are not buying a system that are identical to each other and what we are really getting is a value add that the physician, population who already know, how tho drive the system. we do not have to take risk, where it is not needed.

thank you. >> greg and i am the last one in the string here. so, on the cost of the system, this is a very major undertaking. it is a multi year effort and supervisor, farrell as you alluded to, this is something that the health systems across the bay area and the state and the country are doing. they are large, and cost and investments but they are, viewed nowadays, as kind of the center piece of a health system's ability to provide care. we don't have a final cost, since what we are asking for you today, is simply permission to enter into negotiations. we do have an estimate, that we have developed, to give you a sense of where that is headed. and we estimate a ten year, net

cost of 181 million dollars and that includes, the cost increases offset by savings that we would have for the retiring existing systems and the operational, savings. i want to point out that that cost is a large cost, but that is not just the cost of buying software, and bill alluded to this. that the actual purchase of the license, of the product is a relatively small fraction of that cost. a lot of the cost involves that the development of our internal infrastructure and put the processes in place, and training our staff, and getting our work flows aligned internally. and our billing infrastructure, set up. and so what we are really, including in this figure, that we are showing you, is not a piece of software, and it is a program that will occur over the multiple years that really kind of changes the way that we are operating our healthcare delivery system.

so, we --. >> real quick, what is the break down between that then? >> the actual cost of just the license itself, is about -- 22 million. of that $181. >> got it. thanks. >> so, in terms of the financing plan you have seen, some of this in the budget that was approved for the current two year budget for 15, 16, 17, and you will see more in the coming budget, and we have a financing approach that includes, a variety of sources, that is existing appropriations again, that are already in base budget, after last year's process. and we have hospital revenues, that will continue, or contribute to the funding of this system. and this has been our top priority in the budget process, and so we really focused on reallocating the resources from within the department and towards this he v effort and you will see that in our budget in june and lastly we do believe

that there is an opportunity to get, support as we have recently for the other initiatives by the virtue of the fact that this is an innovative partnership model, where we are bringing in the two systems together and the san francisco general hospital, foundation, has indicated that they are interested in this as a potential source for donations, and that they are willing to work with us to help us see what we can do to offset the costs. lastly, is barbara mentioned, this is not only our clinical care system, this is our core building system. so all of those clinical records, get translated into bills, that are submitted to medicare and private insurance, and we use those to support a very large amount of revenue throughout the network. and so this is in addition to being clinical and a priority

and it is a very, significant financial priority, for the department to maintain the financial health over the coming years. so, again, here is a very brief summary of the estimated costs and sources. we have about 68 million dollars that is appropriate ated to date, and you will be seeing another roughly, 17 million dollars, that we have balanced around, within our budget instruction targets, in the budget submission, coming to you in june. and we will still have some work to do to finalize that funding package. as we go forward, over the coming years. but we have the core of the financing plan in place. through the budget in our financial plan that we are submitting. >> so, again, just to kind of summarize where we are. and the ordinance, that we have

before you today, is requesting that based on the benefits that we believe that we can receive in terms of clinical, patient safety and patient care, better data for medical research, and population, health research, and we think that those are benefits that are achievable, by virtue of the partnership with the ucsf and that if we leverage that and we can get a benefit for our patients that we cannot get in any other way. it is not simply, selecting and we have vendor, and we are saying that we want to pick one of them. we are saying that we want to go a different approach and then turn to a public, sector partnership that we think ko do unique and that is why we brought this ordinance to you today. to request your authority to enter into negotiations with ucsf. to see if we can make this agreement work, and enter into a partnership and the authority is

limited to this project only. and if we are able to negotiate, in an agreement, and that will return to the board of supervisors for approval prior to anything happening. and so we are really asking for today, is for not to approve a contract, is to enter into the process of trying to negotiate a contract. >> we are happy to answer any of the questions that you have. >> thank you. just to confirm, if we were to go forward today, whenever the contract would be up it would be back before the budget and finance committee and the full board. >> absolutely and that is specified in the ordinance. >> i am sure that my colleagues have questions. i guess the one natural one is to say, okay. if it is a 181, let's leave the integrated discussion for the for the patients, which i think that is critically important and leave that off of the table. and i understand everything. but on a pure financial buy sis, 181, over ten or nine years, 20

million a year here. which includes, capitol and operations for the system. what would it be i mean it is hard to say, what anticipate and the existing costs are $10 million a year. with the existing vendor, that will continue to escalate or how would you assess that? >> yeah, so, in the model that we have that will escalate. we have an issue ch the existing system and it is especially our hospital, inpatient and our billing system for the hospital and primary care, is coming to the end of its usefulness. we are still using it. but, it is out dated. so, it is not a long term viable solution. we have assumed in the numbers that we have given you is that we have just taken that 10 million and said that goes away so that we will apply to offset against the cost. in addition we have assumed some savings verses the 5 year,

financial plan, in our costs that are anticipated particularly in the physician, provider contract where we believe and our ucsf h, believes that if we are able to implement this system, it will result in additional billing for them for the professional services and the operations and that will reduce the cost to the department to purchase its physician services. >> there are two those. >> thanks. >> supervisor yee? >> i think that you made a comment that the numbers that you are giving me is sort of a guess or an estimate. and what guarantee do we have if you do go, and negotiate with ukr. sf for them to say, wow, where we are only, going to be able to do this. and come back with a contract that is actually going to be

substantially more than what you had estimated? is there any? >> way to sort of prevent that? >> absolutely. that is a good question. supervisor. so a couple of issues, are, we are asking the authority to negotiate, but we always have a plan b for ourselves. we do have financial constraints, and we know that the city has financial constraints and that is at the top of my mind. and so we are going to go into this and attempt to negotiate something that we can afford and that works technically and operationally. if we can't, we always have a plan b for yourselves, our plan b would be that if we can't make that work, then we will go to a different option and one of the criterias is going to be if we can negotiate a contract that we can afford. and so, there is no assurance that we will be able to negotiate it. but, there is an assurance that if there is a contract that we cannot afford within our financial plans, we would not be

able to bring it back, and to say that we have the dollars to front it, and again, that contract would come back for the board of supervisors budget analyst for approval, if we are able to complete negotiations. >> i know that you are in the odd situation, once you put the numbers out, it is almost, a guarantee, that the contract will not be any less than this. since you are saying to them that is how much that you have. >> you know, we i think that you are right. you know we wanted to put some numbers out so that you have a sense in your oversight role of what we are looking at, but, these number are not magical and we are going to negotiate and we are going to go into detail into what the costs are. and we have done a solicitation for vendor support to assist us in negotiation and go through and do a review.

of what is proposed in the contract. from an independent third party. perspective. and to advise us on what the deals usually look like, when we were made out in the larger world. so we will have some advice, and set the support for ourselves to identify where we are, and are not getting a good deal. and we said that there is a little bit of that dynamic, but we will be committed to getting the best deal that we can for our department and we need to do that for the financial viability as well as the city's. >> and in regards to the means benefit, estimates or, you know, to the cost savings, can you, what is causing the spike from your 2017, to 2018? or the other way? 10 million to 24 million?

>> oh, in the budget analyst report. okay so there are a couple of different elements that are included in those savings. so that the ten million dollars, is our existing cost for certain contracts that we will be able to retire under once we replaced that system and so we would no longer have to run the systems it is a fairly conservative number. the other aspect of this is if you would look at our history and the city's five year, financial forecast, we for, the physician services at san francisco, general hospital we use the school of medicine physicians and residents to provide those services and we paid for them for the services that they are not reimbursed through. as we have gone into this, if we have a system that is able to

optimize our operating*- we will

be able to retire those systems and our contracts and so that is our hospital, and inpatient and billing system, it is our ambulatory care and our primary care and ehr that is in the primary care and other supporting products that we are purchasing and so both the new cost. >> and so that i think my point, really is, right now you have a net total cost of 181 million. i am just thinking, that what you have not incorporated in through the city is not really a savings, but you would have to come up with it a new system that is going to cost you money. so, it is not truly, 181 million that you have to spend the extra. because you would have to spend the money to have the new system. >> absolutely. >> and that the cost of that new system is on the cost side, so you will see that there is added cost of 340 million and

partially offset and so it is a net cost to us that we have been working on applying for. thank you. >> supervisor, tang? >> thank you very much for the explanation and i think that again, it is very clear the need for a new system, and one that is clearly a lot more integrated. since the item before us is about waving a competitive so listation process, i was wondering that there have been concerns about not going forward with the rfp process and could you talk about why dph decided or is bringing north this item. >> sure. >> thank you for the question. and i do want to say, we understand that and we get the benefits of an rfp and i have never asked for this type of permission before i don't expect to, again. but it really is because of the unique nature of this situation that we are in. so i think that the way that we are really thinking about it is, this is not a situation where

you have vendors that can provide you a product that all can kind of do it and you are going out, and looking for the best cost for a similar product or the best quality. that is part of what is out there. and that could be where we end up at some point. but what we are really doing proposing here, and the way that we are looking at this, is this is kind of a different route, instead of just buying a product from a vendor, we are proposing to say, let's take a different approach and go with a government to government agreement where we are leveraging both their system and their operations. and the reason that we are doing that, is because we have kind of come to realize, that by virtue of that partnership, and not by virtue of what the software is or what the system is, it is the partnership itself, that we can do something good for our patient and that we can contribute to the medical

research, and the popular, health management of the city and since it is by virtue of the partnership itself, there is by definition, not really another path that we can take to achieve those benefits for a patient population, so you kind of have an apples to oranges situation where there is really only one path that we can take that gets us all of those things that we see that are available to us. and so, seeing that, in front of us, if you are doing an rfp process where you are comparing apples to oranges, you kind of have a strange situation where you are either focusing our rfp just to capture those things and you can only get in one place, or you are putting yourself at risk for getting something that will be less than opt mal for your patients. and so seeing that situation, we determined that we wanted to come bring this to the board. and say here is what we see, we

think that there is a unique opportunity to do things in a different way that will have real benefits for health system, and seek your support to pursue that alternative. if we did not, or if we were not able to achieve what we opened that we will be able to achieve with the ucsf whether for the financial reasons or the technical reasons or whatever it will be, i think that we will be back in a more standard place, where we will be building our own system and it will be more of a scenario where we are saying, that we need our system, which is the best product for us to go out and purchase. >> so i think that i get that, distinction ad so, what if, and let's just say that you were to do an rfp, would that also be the process or the place for you to explore, whether this partnership, would work out? >> well, it is a good question. and i think that there are a couple of concerns that we have about that route. we did think about this. and evaluate it.

the first is, that we are again, proposing to negotiate with ucsf, they have a system that they have bought from a vendor, but our negotiations and ultimately our agreement would be with ucsf and not a vendor, so there is not a precedent that i am aware of for the governmental entity to bid and compete through an rfp process of this nature, ucsf bids on the patient, community care contracts with us, but those are service contracts. this is unchartered territory of how the government to government, partnership will work, the second issue is if we were to go through a process of your standard rfp process, what

does that look like? we want a vendor that will, be or provider of care and especially services for the population that trains our figureses. and if we did, and there will really only be one respondent and cap able. and meeting those criteria, if we don't include those and then we don't capture those benefits in our evaluation. and so that was our logic and our thinking on why, because this is such a unique, situation, it does not lend itself to the normal process that is -- >> thank you. >> okay. if no other questions fl rose could we go to your report, please? >> yes, mr. chairman. the members of the committee, on page 17 of our report we note

that the actual projected expenditures from july, first 2010, to june, 30, under the existing contract, the electronic healthcare system, between dph, is 52.3 million, and that is shown on table one, and again, on page, 176 our report. and the board of supervisors has appropriate ated the general fund moneys for the existing contract. we also know that as shown in table two on page 17, of our report, dph estimates that the contract with ucsf will cost estimated $341,919,891, over the nine to ten years and dph and anticipates the savings of 160 million. and from the discontinuation of the existing systems, and reduced to the growth in the cost for the services which will result in the total net cost of

$181 million. and for the contract. and again that is shown in the table two. on page, 19, of our report, we do know that a competitive request for the proposals and process will insure that all eligible vendors are able to apply and strengthen the city's after ability to secure the most qualified price for the needed services. and our recommendations on page 20, recommend that you amend the proposal that dph, issue a request for the proposals. if dph is unable to attain the sufficient assurances that ucsf will be able to meet the criteria, and we consider it as amended to be the policy matter for the board of supervisors. >> thank you, there rose. >> no other questions, we will

open it up to public comment. i have a number of speaker cards. sue car lyle and jim marks, and cluade and kneel, and hedie and dr. church well. >> good morning, supervisors. good morng. >> i am the vice dean for the school of medicine. and today, i strongly urge you to support director cer garcia' request to allow the negotiation to begin, for an net cost expansion of the epic system to include, dph. there have been extensive as you have heard, internal and external evaluations of this, and a con ses sense has been achieved. and the ucsf, city and county of san francisco, partnership, has

spanned nearly, 150 years, and together as we prepare to go into the opening of our magnificent, new and mark zuckerberg san francisco, trauma center, i urge you to exercise the necessity of the timely, implementation of technologies that will insure the best care for our patients, the adoption of the epic system for the did. ph will not only benefit, our patients but also enhance our practice environment for the 1,000 physicians and 900 trainees, many of which are already, trained to use the system. as you have heard there is also, significant opportunities for increased revenue through improved efficiencies and better

documentation. so again, i strongly urge you to consider this proposal. thank you. >> next speaker, please? >> good afternoon, supervisors my name is jim marks and i am the chief of 1,000 plus, medical staff. at san francisco, general and with my colleagues i am here in support for the ordinance to acquire an emr with the unique features that best serve our patients and providers. you have heard that we use paper electronic, and records as well as over 60 different records. and fk, when i care for the critically ill patients i cannot see the care or the medications that they have received in the emergency department. and we are making and the

regulatory challenges in the environment in which we practice and, we now have the opportunity to solve these challenges by negotiating the acquisition of apex and ucsf, implementation of epic and going this route, offers the substantial benefits to the patients and staff, compared to the other alternatives. and as you have heard, half of our physicians work at ucsf, and regularly use apex and this reduces the training costs and more importantly, increases safety because the physicians do not have to know and use two different emrs. and simply, all of our resident and fellow trainees know and use it with the same advantages, i cannot over emphasize the importance of this and insuring the patient safety with a workforce that moves back and forth between the two --

>> thank you very much. >> appreciate it, next speaker please? >> good afternoon. i am the chief of neurology and the director at san francisco general. integrated electronic health record is a required tool of the trade for the doctors and nurses to get the care for the inpatients and outpatients when i announced at our faculty meeting that the director garcia was seeking to bring it to the hospital, the faculty actually applauded and the residents say thank you, and i am inspired on a daily basis for the dedication of the providers on behalf of the patients across the care, continuum from the emergency, fair treatment, and implementation of the ehr is a

major undertaking and having the enthusiasm and the engagement in the medical staff is critical to success and we have it for director garcia's proposal. >> they need to spend the time not learning a no. uhr and it is a safety, issue, when the provider, works in the hospitals as most of the doctors do is treating a stroke, patient in the emergency, department and when the minutes mean brain cells, any delay, brought by the infa familiarity is unacceptable, and when the doctor follows a patient in the outpatient, clinic it is at a different hospital that day and they need to be able to seamlessly, access the patient's medical record from off site. and it is a mission, issue. the it is a special place and the link, will insure that the patients are at the center of our commitments to the patient care, and medical education and, research.

on behalf of the service, and medical staff, i urge you to support this ordinance. thank you. >> thank you. >> next speaker. >> good morning. i am neil and a physician and a chief of medicine. and we are the largest department and we take care of people in this city, with heart attacks and diabetes and high blood pressure and hiv. if you have an iphone, imagine if you were forced to use an android this month and an ifor enin april and android in april and iphone in june and android in july. you would become, quickly frustrated. you might make a mistake, dialling or texting the wrong phone number because you are not familiar with the software features that is what it is like for the 1,000, ucsf physicians at san francisco general who

provide, primary and specialty care to 123,000 san francisco residents. and they have to toggle between the two different electronic health records. systems. one at ucsf and a totally different one at san francisco general as they go back and forth boetween the institutions losing your bearing in the electronic health record is not as trivia as texting the wrong phone and saying excuse me, it could mean the delays in care and patient harm and death for a patient treated by a physician, having to use, two widely different information systems. imagine ordering the wrong medication because of unfamiliar arty with two systems. and not only a human cost for the adults. or the children, like the ones that were just in this chamber, but there is also, the grief for providers and unnecessary cofor tax payers and you have the

power to prevent this. and behalf of the chiefs of service i ask you to support this non-competitive process. to advance the health and well-being of san francisco residents. >> thank you. >> next speaker, please. >> hello, heidi collins and iment the vice president of ucfhealth for the health record and the systems, at 5 hospitals and over 160 hospital and community based clinics. and i wanted to give the historical background on ucsf road to the successful implementation. and prior to epic, it undertook a nine year journey to implement the functionality, this project had multiple stops and starts.

>> thanks, the next speaker, please? >> good afternoon, i am scott kene senior director and general manager with the health services a division of the corporation, required. the services february of 2015, it has been the electronic health and partner for dph for 20 plus years and we value our relationship. i am here today, in support of the letter flanagan shared with

the board of supervisors regarding the waving of the competitive process requirements. for the selection of a new ehr and naming ucsf as the preferred contractor. we believe that it is not in the public's best interest to wave the competitive process and allow the sole source of the complex and high risk, 342 million dollar, information technology contract. we are asking that the competitive process remain in place, the competitive process, provides, dph the opportunity to fairly evaluate the key factors which include, an integrated system that meets the unique needs of the dph across the full care. and in addition to the exchange of information, with non-affiliated epic partners, service level agreements for out time, warranty and support levels and a fixed fee implementation and the total cost of ownership. there are no examples of two

organizations as large as ucsf and dph with different service lines and government structures coming together in a shared system. this is a very important long term project and we urge the board of supervisors to reject the wave request and follow the normal competitive process, that will allow dph to select a supplier that can meet their unique needs. thank you. >> next speaker, please? >> good afternoon, supervisors, my name is eloise and i am a san francisco resident and i do not have a slew of initials behind my name as t the ladies and gentlemen before me. it is a great need and it needs to happen and no one has the passion of the members of the san francisco community more than i do. this goes far beyond the project. the concern is that we are being

asked to wav administrative code 21.1, which actually is a protection for business? san francisco, and dph even stated this is for the business of health. well the business and small business of san francisco, have not had the opportunity to engage with anyone. to partner with anyone. and to move forward to be able to be included in this process. this sets a dangerous precedent. and as we move forward, this is a significant amount of money to the sole source of individuals and not to mention that the data that ucsf is going to be able to accrue and going to be of a great value to them and provide, more dollars into the network as we move forward and we begin to negotiate and negate 21.1, then all of the other contracts that are other larger constitutional contracts that are coming down the way will get much more scrutiny than this one is appears is getting right now.

so, i absolutely urge you to reject this as and provide a waiver, and absolutely encourage you to move forward do a competitive process as this administrative code was desiepd to do. thank you. >> thank you. >> next speaker. >> ♪ >> if you are searching for your health records i am sure that you will find the information there. if you are searching for health records systems. i am sure you will find it helpful safe in there. >> thank you. any other members of the public

wish to comment? >> okay. seeing none, public comment is closed. >> i will just say from my point of view, i never, we don't like doing these, and or it is not of the preference to do these type of source things but from the process perspective that is why we have the ability to wave it if we need to. and i am, very conscious of the economics here and i will say from my perspective. the integration, here from the doctors and the health department and i will just say that a personal experience and my folks over the last few years, the integrated system at ucsf and it is, critical. and i cannot imagine and i would not be in conscious not voting for it. knowing how critical that it has been to their personal healthcare. and not being able to give everybody else the opportunity to do that. so, i understand all of the other kernshz i get it.

but from my perspective, when it comes to it all, it trumps it all, i am prepared to approve this right now, and we are going to have the full contract before us and we can evaluate it at that time. that is why we have this procedure in place right now. and i would be happy to support it. tang? >> thank you, i do echo, sperp farrell's comments and also i will make a motion now then to accept the budget analyst's recommendation that if there not an agreement, reached in six months, that the department will go forthwith the rfp process. so, with that, then, i would make that motion for amendment and then, send forward to the full board with the positive recommendation as amended. >> okay. we have a motion by supervisor tang. >> and we can take that without objection. >> mr. clerk, do we have any other business in front of us? >> on the previous, item, i believe that dph was wanted to

propose an amendment that was different from the recommendation of the budget analyst. and i am happy to read that into the record, i don't know if --. >> sure, >> the only difference is if you look at the budget and legislative analyst report, the recommendation is phrased slightly different from the body of the report, than it is in the bullet point at the end. one version says if we are unable to conclude negotiations, in six months, we go to rfp, and the body of the report it says if the director of health is unable to obtain substantial assurances under subsection b of e ordinance, that we will go to an rfp. and we would prefer significant assurances language, because it does not lock us into that hard deadline. >> and we agree with that. with he discussed that with the department and the wording that i read to you, today, is consistent with that. so we are in agreement with the department.

>> thank you. mr. rose. >> do we need a different vote at this point? >> i think that your vote is okay. if it is consistent with the regular dagss. but just one point of clarification, in the write up to the clerk, we will not say that the department has to go with an rfp, if the negotiations break down, but that it has to go with a competitive sola solicitation process, which could be a range of options. >> no other vote needed? in no. >> any other business in front of us. >> i would like to request that the department provide the am d amended ordinance to me by 9:00 m a, tomorrow morning at the late. e >> okay. >> with that, we are adjourned.

>> good afternoon, everybody, welcome to the san francisco board of supervisor's budget and finance committee for wednesday march 9, 2016. my name is mark farrell, i will be chairing this committee, i'm joined by supervisor katy tang as well as supervisors jane kim and scott wiener, we'll be joined by supervisor norman yee and i want to welcome supervisor avalos, i want to thank victor young, the clerk, and jennifer low and [inaudible] mr. clerk, do we have announcements? >> yes, please silence all cell phone and is electronic device, any documents to be included as part of the file

should be submit today the clerk, items will appear on the march 15, 2016 board of supervisors agenda unless otherwise stated. >> thank you, mr. clerk, we're just making sure we deal with a quorum and over the limit issues, and we'll ko*n the deal with that today. with that, mr. clerk, would you call item number 1, please. er >> item number 1, ordinance appropriating 5 million dollars from the general fund reserve of which 2.5 million will be used in the recreation and park department nor facilities improvement ins the geneva car barn and 2.5 million will be use ined the department of public health for facilities improvements of 35-45 onondaga avenue in fiscal year 2015-16. er >> okay, this item was sponsored by supervisor avalos, so i would like to turn it over to him. er >> thank you, chair farrell and i want to appreciate the work of the budget committee to hear this item and also for all the previous work that the board of supervisors

has done for the geneva car barn and the newest version or newbesting building that we're trying to restore in district 11 are the emergency hospital on onondaga and the home and health site on onondaga and elevate, these latitude buildings are two public buildings under the department of public health jurisdiction that had been empty, i believe it's been around 7 years that they've both been empty, they've been sources of blight fwl the neighborhood and just along the corner of alamani and onondaga, there have been homeless encampments there on the build, there's been people squatting inside the building as of last year, the corner building and it's also a part of the commercial corridor in district 11 that we're trying desperate toy to bring up to viability and economic viability, we've made some really good improvements close by on that

corner, but you know, being able to activate vacant buildings is going to be a major part of our effort to bring economic vitality to this part of san francisco. and, clearly, we look at ways that san francisco outside of district 11, outside of the southern neighborhoods have faired during our economic boom, we've seen a complete transformation of partser of the city, that hasn't happened in district 11 and that's really why i brought it forward, this supplemental, to help level the playing field for district 11 to see that we can get, while we're having this boom, some of the wealth the city's been able to generate to come into our neighborhood and help jump start the economic vitality that so far has not really blossomed in district 11 as it has in other places. the geneva car barn, part aof the supplemental is 2.5

million dollars for phase 1 of the building construction that we've been working on for the past 15 years or so, and phase 1 would be on the power house side, it's a big vacant billing where there were power generators, it's incredible, beautiful site but it's not been easy to activate it and to raise the funds to do it. over the years, the city has made appropriations with the support of the budget committee for the geneva office building, i believe there was about 800 thousand dollars in 2008 that was donated or appropriated and then we've made appropriations during our add back process to keep programming going and to keep fundraising going for the car barn, that's pretty much kept this program alive and then a couple of years ago, rec and park was able to find, they called it looking at the couch cushions to find money

that was left over from bond financing that hasn't been expended to be able to use for the car bafrn as well and that has been made available to help to do some of the design work and predevelopment work that has been so necessary to keep this project going. phase 1, we were able to identify three million dollars from the last park bond that was approved in 2012, there's funds that could be going for the car barn and they were pretty much designed for the car barn project, there's also about 1.6 million dollars in historic tax credits that can be applied as well and then this 2.5 million dollars is to cover the gap to be able o do the entire phase 1 of the project when you combine with the tax credits and the previous appropriation, so i want to thank the mayor's office for their openness to discussing how this project can go forward, so far t

mayor's office has not indicated that they are -- believe that the supplemental is the appropriate way to go and would like to consider putting this in their budget, no matter what, i want to see -- and district 11 residents want to see that this is a project that can move forward this year, that we could have fund tog do this phase 1 of the car barn this year. the onondaga sites are going to be more challenging, w ve a budget analyst report that has not been favorable for that site compared to the car barn which gives us the bajt analyst has given us a favorable recommendation to approve the car barn side, we don't have that for the onondaga site and that's about more how we're trying to collect information for the onondaga site that would allow us to bring the economics to something that would be much more easy to

do with our city funds, so i'm expecting that we're going to continue that part of the supplemental before us today, the part related to the two buildings on onondaga and see if we can find some other pathway for those. i know the community is really interested in those buildings moving forward quickly, we ao*f had as i mentioned before, they've been languishing for 7 years, source of blight in the neighborhood and there's a real interest from district 11 residents to move on these project, overall for the supplemental, we received a lot of e-ail and is public input, about 20 e-mails from people in district 11 to move forward on these project, but finding the funds and the pathway to find the funds is not totally clear, so with that, i would like to perhaps hear from maybe the mayor's budget office on what work

so far they've been able to do on helping us to move forward with these projects, i'm very grateful for their work and helping to find funding, and want to continue a conversation on these projects as we move forward for the next week. ing >> it's not to interrupt, ms. howard, i want to say i am going to -- because we're dealing with issues of too many people here in the chambers at one time, i'm going to excuse myself out of the chambers bhiel this discussions until the actual vote, so i will be here for the vote in a little bit and supervisor avalos at the time with we do have the vote, if you can excuseyourself and i'll come back in, so we can have six people at a time that create as quorum. >> i've been on the budget committee, this is my sixth year, every single year, i've haed a request that every single five person budget agenda that's issued have the special language on it if a sixth member comes in, it becomes a special meeting of the board of supervisors,

and that language almost never comes on, it seems like every yaoe, we have this problem where if a sponsor god forbid comes in to talk ability their item or someone on a particular budget matter, all of a sudden a member of this committee then has to leave, and i just -- i'm going to request again to the clerk's office that every single agenda for the big budget committee include that disclaimer, there's no reason not to put it on and it just -- it will address a lot of these problems. >> thank you, supervisor wiener, and i just had that same conversation, that's going to be the case through the rest of our big budget season in the board, with that, i will go out of the room and come back after the discussion. >> thank you for your flexibility. >> mayor's budget direct torx i see you've stood up. >> good afternoon, supervisors, supervisor avalos, members of the

committee, kate howard, the mayor's budget director, thank you for your opening commenpervisor avalos, as you know, we've been working closely with your office with the rec and park department and the office of economic and workforce development over the past several years to figure out a plan to move the car barn project forward. last year, work done by your office, rec and park and oewd resulted in a modified phased plan for activating the car barn and the power house, and the planning work for that modified plan was funded through the mayor's budget at about 475 thousand dollars. the mayor's office is happy to continue to work with you and your office to figure out an appropriate strategy for fully funding the project, as i think i've shared with

you, at this time, it's very difficult for our office to support general fund supplementals given the city's financial outlook, we've put out budget instructions that demonstrate that we have budgetary gaps growing from 100 million to 240 million dollars over the next two years so we'd like the work with you through the budget process through the capital planning committee to make sure that we're able to address the needs of the project but to do it in the context of the budget. happy to continue to work with you over the next weeks and months to figure this out, but that's kind of where we are to date. >> okay, and are you part of the kettle planning committee? >> i am, supervisor, there are five permanent members of which i am one, the board president is the board's representative on the capital planning committee.

>> and how much has the actual car barn brojt been a discussion item on the capital planning committee, if ever? >> i don't know the answer to that off the top of my head. it may have come up, if it has come up, it would have come up as part of the rec and park discussion around rec and park facility needs. i'm happy to look at that and certainly happy to work with them to bring it to the committee's attention. >> i would like to see if we can have it as a topic item for the capital planning committee. i have not participate painted on the capital planning committee in the past tha,'s been a place where the president of the board represents us, but i think in this case, given that we've worked for many years on the j*e geneva office car barn project, we should elevate it to a real discussion because we've made the commitments here in budget committee and the

mayor's of fices made some commitments but we haven't had a thorough look at how we can make sure this project goes forward, and we make plans outside of the capital planning committee for this project that i don't think makes a lot of sense that the capital planning committee isn't part of that discussion, so to be very honest, i have very mixed feelings about whether to move forward with a supplemental. i feel like that's the only way i can guarantee that we can move forward on this project and i think we might have enough votes to pass, but i don't know if the mayor would vito that, really having the mayor's support no matter what is going to be what makes or breaks this project, and so i want to keep the lines of communication open. what i expect to do with this item is to probably just continue it a week, ms. howard, you talked about wanting to talk directly to

the mayor about this project, if i could be part of that discussion again before hearing it again next week, that's something i would like to do. there are people who are from district 11 who would like to talk about this project and how meaningful it is, i think it's important na the committee hear their response, we also have the budget analyst review his report and if we can -- >> thank you, maybe i'll go the supervisor yee first and then to the budget analyst. >> thank you, supervisor avalos, for bringing the car barn issue into our attention. even though it's not in district 7, it borders district 7, and i've had the opportunity on i -- and i suppose other supervisors have had the opportunity to visit the car barn, and when i went to visit it, i was just using my imagination, whatever the people that were

giving me the tour wasn't telling me, and i looked at it as such a humongous asset, not only for district 11 or 7 but i think throughout the city, it's a great building to make something happen there, some of the plans, some of the discussions that was taking place when i was on the tour made so much sense in terms of what it could be. i really saw the potential there, and i'm glad you're taking a lead to try to push this becausit's been in discussion for years and i would like to strongly support supervisor avalos in trying to realize this project in the near future, so i will be supporting a continuance and i would like to hear what the mayor's office will be doing with this.

thank you. >> so, if there are no other questions or comments, maybe we'll go to mr. rose first. >> yes, madam chair and members of the committee, on page 5 of our report, we state that it's shown in table 2, the projected funding sources total 7 million 501 thousand 278 which is 618066 more than the 6 million 88312 phase 1 powerest maltese cost shown in table 1, again, that's on page 5, however shown in table 2, only 601 thousand 278 has previously been appropriated by the board of supervisors for this project, so this leaves a current 6 million 281, 934 funding gap for the phase 1 project related to the power house hof the car barn project. on page 6 of our report, we

note that funding for phase 2 of the geneva car barn project has not been identified which is currently estimated to cost 22 million 116 thousand 788, regarding the 3545 onondaga avenue project, table 3 and that's on page 6 of our report summarizes the estimated cost for short and long term improvements for that project and it's shown in table 3, the estimated costs range from 3 million 35 thousand for short term improvements to 4 million 903 thousand for long term improvements. on page 8 of our report, we notice that the city's general fund reserve balance is currently 73 million 931, 443, if the board of supervisor approves the proposed 5 million supplemental appropriation ordinance t general fund reserve would be reduced to 68*f 68 million 941443, our

recommendations on page 8 based on the prior appropriations previously approved by the board of supervisor, we have recommended you sever the proposed ordinance to separate the 5 million request into two, 2 million 500 thousand dollar requests, one for the geneva car barn and one for the onondaga properties waeshltion recommend you approve the requested 2.5 million supplemental appropriation for rpd for the geneva car barn and place the entire 2.5 million on budget and finance committee reserve, pend thing determination of the remaining funding sources and the actual amounts of funding received for the project. we also recommend that you continue the proposed 2 million 500 thousand supplemental for dph pending the identification of additional funding sources, actual amounts of funding received and the organizational structures

determined to close the gap to renovate and close the 4545 onondaga property debra newman and i would be happy to respond to any questions. >> thank you, mr. rose, any other comment? s seeing none, we'll go over to public comment on item 1. i have one public comment cardfeel free to come on up and line up. anyone wishing to speak to item 1, line up by the window over there and line up, come on up. >> good afternoon, and thank you for the opportunity to comment regarding your vote today to approve supplemental funding for the reuse and revitalization of the geneva car barn and onondaga property i ao*e been a city resident for 37 years, a homeowner one block from the je geneva car barn for 16 years, like my neighborhood david hooper and carl notty,

i have a long perspective on city planning model, i can see how long it takes to make improvements in an area designated for planning. we unfortunately still have conditions of neglect in district 11 today. my business has been helping provide needed housing and commercial opportunities in areas that are ready for improvement and are in need. the key to success for me is a central point in which to orient good planing and a neighborhood identity. what seems to be the necessary key to redevelop an existing neighborhood is an anchor, a safe that identifies a special location through its history or its importance. the specific location at geneva and san jose avenues is a busy transit nexus for thousands, and it can become the center of new community cohesion and productivity while honoring its past and serving its future of the city and the community there.

think of your aye vote as your voice of confidence that district 11 will not be forgotten again during more belt tightening times, that the taxes we have sent you will be used for the very improvements we need to revitalize this busy intersection. please cast your aye vote today to support supervisor avalos' supplemental budget request for this prongt and help fund part of the vitalization of district 11. thank you. >> thank you very much. next speaker, please. >> good afternoon, my name is robert mule bar, i'm here to speak in favor of the 5 million dollar supplemental appropriation for geneva car barn and the alamana hospital, i'm a 35 year resident of this community, i'm former chair and i also serve as the balboa citizens advisory committee, the

balboa station area where both these committees are working which was adopted by the board i believe in 2009 really says that this transit node where this geneva car barn is located really has a sense of identity, it does not have a sense of identity at all right now, it is an undesirable place to go but there's all kinds of good signs on horizon that something's going to happen here, there's 85-100 proposed house tog go up, we have sfmta that's going to be doing street improvement, there's an ntip grant that's going to be looking at the intersection of geneva and san jose and across the street, here's our geneva car barn, our historic landmark building that could be the catalyst for coming together all these improvements, bart's putting in about 12-15 million dollars of improvements so i think our time is now and i would like to see through this

supplemental budget appropriation or part of the budget process that we move this project forward and create a neighborhood asset that really it should be, it's a diamond nr the rough and it could be something much better and actually if we're going to put 85 units of housing at this location, it just can't be done in isolation, it has to be done in the context of all the other improvement that is are taking place, so once again, i urge you either through the budget process or both through the supplemental appropriation that we move ahead with this. thank you very much, and i appreciate your time. >> thank you very much, next speaker, please. >> overhead projector. my name's rich chord rof man and i'm not a district 10 resident but i am interested in preserving murals, wpa mural ins the city and i

found out about -- i thought the mother's building was hidden murals, but these two murals, [inaudible] he painted these in the tower, this mural and the fwo murals up at ucsf, this building was occupied by public health and for some reason in the 30's, they whitewashed the bottom probably because there was some inappropriate scenes in the murals there. here's a close-up here, actually, bernard zakime's grandson startled the process of cleaning these murals here. and then this is a mural on the second floor here, community health, the bottom one is called growth, and i think, you know, we save quite tow e beach shall lay

and -- chalet, and i think we need to save this building and this building needs to be open to the public so the public can enjoy these beautiful murals, they have been closed for a long time and i think either the city needs to own the building or the non-profit group and to have the building so that it's open to the public and the community and the public can enjoy these beautiful murals. here's one of the artist's, one of the great artist's in the wpa and i think we need to honor him by showing his murals to the public. thank you. >> thank you very much. >> thank you, mr. rof man, before the next speaker, i neglected to have katie who's here from the rec and park department who came here especially to be part of our hearing and she could talk about a lot of the work the department of rec and parks

have done for the geneva car barn, so thank you for coming. inger >> i'm kate tea patricioni, so rec and park purchase ted je *f geneva car barn from money in 2004 for $1, and we have spent the last 12 years or so since then working to realize a vision of converting the space into a center for youth arts programming. we have had many partners throughout this process including the friends of the car barn, the office of workforce and he can nom i can development, the arts commission as well as the long-time support of supervisor avalos and the mayor. in 2015, the budget analyst report noted, the department made the decision to split what has become a very complex project into two

phases, the hope being that if we could complete phase 1 which is a renovation of the power house, that would really excite philanthropic support to help us fund phase 2 of the project which is substantially larger. the supplemental that is in front of the committee today would close a budget gap for phase 1 of the project, rec and park is very committed to the car barn project and we look forward to continuing to work with supervisor avalos as well as the mayor's office to secure all necessary funding for the project. i'm happy to answer questions. >> thank you. >> alright, seeing no questions, thank you very much. >> supervisor yee? >> thanks for your presentation and your support for this project. i'm just curious, when you

say rec and park is committed, i know that you've paid attention to it, but has rec and park actually committed any resources, funding to this particular project? >> can i answer that before you do? rec and park has been a great player and collaborator with us on this project, and i'll let katie talk about that more, but over the past several years, nicole avril has been a leader in helping to make sure that the rec and park department has been on it, looking at ways we can find money, making sure that the environmental document that is were done a few years ago were done, it's night and day where rec and park was maybe 6 years ago to now and i'm grateful for their efforts so i'll let katie also chime in there too. >> so, we support the

project in that we have a project manager who's working on shepherding all of the financial and entitlement and planning of the project through the process, but then also there's three million dollars in -- -- earmarked in community opportunity fund ining the 2012 bond for the car barn, so i would say we are putting our money where our mouth is. >> thank you. >> thank you, any other questions, comments for rec, park, seeing none, we're going to resume paub u public comment, so next speaker, please. >> good afternoon, supervisors, my name's linda lighthouse, i'm a resident of district 11, my husband and i have written a letter which you probably received today, so i will just give you a few highlights, we are firmly in favor of this process of

extra supplemental money for this neighborhood. we've been in san francisco since 1969 and we've seen a lot of changes and a lot of progress, but as we see in the neighborhood we live in, lots of these projects that we think should have gone forward much sooner than they did have been stalled and that's primarily due to funding. i'll just give you a couple of excerpts from my later, easier and all my neighborhoods are uniquely diverse neighborhoods who contain some of the most actively and engaged citizen ins the entire city w. we know thousand get things done, we have been honored in multiple category ins the annual empowerment network awards, we have the will and the follow-through but we lack the funding to accomplish our bigger goals, our community is rich in its

enthusiasm, dedication and volunteer spirit, but -- and we feel these buildings symbolize the dreams of what we know our community could be, sadly too many people drive by these buildings see these buildings as a symbol of abandonment of our district by the city, our constant rallying to explain that the wonderful renovations that could make these buildings cornerstones of neighborhood pride are usually met with a cynical but when, thank you. >> thank you very much, next speaker. >> my name is jo*el and i'm president of the merchants and residents association and i urge your support for this supplemental and the 5 million dollars. i was a patient at the mission emergency hospital which was 45 onondaga and many times scraped knees, scraped things like that, shot that is are needed was where we went to go get our immunizations in the

neighborhood, these are two -- the geneva office bar, car barn and also the 34 and 45 onondaga are community build advising we need to have these in our neighborhood because they are necessary, we need to have our own tower, something to have pride in and we as citizens and as residents and as tax payers, i'll throw that in, we really urge you to pass the supplemental. thank you for your time. >> thank you very much, next speaker, please. >> good afternoon, my name is david hooper, i serve as the president of the new mission terrace improvement association and this is my hometown, i was raised in the mission. with regard to the supplemental request, i support it, the geneva office building and the alamania hospital and adjacent buildings have historical, architectural and significance to the

community, they are anchors that haven't been used. as robert mule bower said, the intersection of geneva and san jose needs a real opportunity to make something happen and the gob is that opportunity, as for the 35 and 45 onondaga, the emergency hospital and the adjacent health center buildings, i would like to thank richard rothman for raising the flag and saying the murals there, you have to see nem in person to appreciate them, that he made the effort, last month, the historic preservation commission, is it a commission or a committee? >> it's a commission. >> they voted to landmark unanimously the emergency and the health center building adjacent to it. they're anchors, change is going to come to the excel

sher, we can get ahead of the game, so i would also thank supervisor avalos for trying to rally support with the board of supervisor and is to the mayor's office for the supplemental and one last note, i think i went to all of the emergency hospitals when i was a kid and the geneva office build ising where i took the oral exam to become a muni operator, yes, i passed, and i would like the say that it isn't just me, it's generations in the community identified with these buildings. thank you. >> thank you. next speak -- speaker, please. >> good afternoon, supervisors, i'm dan weaver, today i'm speaking for the board of the friends of geneva office building and power house, needless to say we support the supplemental, we also support the mayor's efforts towards finding the

money to make this project move forward finally. we've been trying to move it forward since 1999 when we persuaded muni or the mayor i should say at the time, willie brown to direct muni to work with the community to restore the building as a community center. our focus has been over the years to focus on the youth and the neighborhood because as rec park leaders told us when they joined us in the partnership in 2003, that that was what was needed, a new way of dealing with recreation, after school programs for youth and that's what the department hadn't been able to achieve and district 11 of course is the perfect place to experiment with things like that and we've been partnering with the rec park department as they've explained earlier

towards getting this thing going, getting it started, getting it operating, and this phased approach is something that is working and we need to continue to make that work, hopefully the mayor will be bemind us sooner -- behind us sooner or later, thank you. >> thank you, next speaker, please. >> good afternoon, supervisor, asha from district 11, i want to support this, [inaudible] this important institution, as well as david hooper and lisa hooper from the mission terrace improvement association and putting the alamani hospital and the health buildings on everyone's radar and the important murals so we stand in support of this today, thanks, supervisor avalos for put ining the request, it's

very important for our community and we would like to see this move forward, thank you. >> thank you very much. next speaker. >> the gee nao*ef va car barn's been there a long time, it's been a long time, been a long time, been a long, long time sm. singing ) why don't you give it a dime, it's been a long time, been a historic long time, been a long, long, long time, won't you make it shine, it's been a long time, been a long time, won't you make it all turn out, public health and shine, thank you. >> thank you very much, any other members of the public who wish to speak on item 1, please come on up, seeing none, we're going the close public comment and pretend to bang the gavel, supervisor wiener? >> i just wanted to thank

supervisor avalos for pushing on this project and really commend the neighbors for pushing for decades now on this project. we know that a lot of times, things only happen when neighbors push for years and years and years, so i'm very supportive of this project, i'm also appreciative that supervisor avalos will be engaging in dialogue with the mayor's office to talk about how we can make this move forward, so i'm hoping we can have a qume buy ya moment and a have a great project. >> thank you, supervise so, any last comments? >> thank you for hearing this and i want to thank rez densest from district 11 for coming out in good numbers today. it's not often we get a lot of district 11 residents to come to public comment during the middle of the day, and so i think it's really special to acknowledge that. i also want to acknowledge for the many people who have

been working for years on these projects, in particular, dan weaver from the geneva office building who has been tireless in his efforts and has been able to mobilize a decade long district 11 support for this project on geneva and san jose avenue, and just more recently, the work around the onondaga sites have been led by a lot of residents but in particular, david hooper from new mission and terrace improvement association, so i want to thank him for his efforts. as mr. rothman mentioned, there's a bernard zack hao*im mural of the comer of onondaga and alamani, that is a significant local treasure and my office has been working with some members of the committee and the zack hao*im family to make sure that mural's going to stay in place, so part of restoring

these buildings is to make sure that that mural will be available for the community x the public to see that will be preserved and that's one of the reasons we've also sought for historical preservation for the health and homesite. so, i really am torn about between rolling the dice today, but i think it would make a lot more sense since i've had a request from the mayor's budget director kate howard to have a conversation with her and the mayor which i will want to do this week and before hearing this item again next week, so what i would like to do is have this item continued. i'm okay accepting at that time maybe next week, we can do the budget analyst recommendations at that time, but overall, we can continue this for one week, i think that would help have that conversation. >> thank you, supervisor avalos. so, if there are no other questions or comments from colleague, i'm going the see if we can get chair farrell

back in the chamber to take action on item 1. >> and i'll have to step out at that point. >> yes. >> do you want to go ahead and make a motion. >> go ahead. >> so, i'm going the make a motion to continue this item for one week. >> second. >> okay, we gt a motion by supervisor yee, second by supervisor tang, can we take that without objection? supervisor kim, do you want to vote on this? we need supervisor kim, would you like to vote on this continuance? okay, can we take it without objection? okay. so moved. >> the matter is continued

for one week. >> alder, mr. clerk, item number 2, please. >> item number 2, resolution amending the city's ten year capital expenditure plan for fiscal year's 2016 through 2025 to provide for the financing of an animal care and control shelt were the execution and delivery of certificates of participation or other forms of indebtedness in accordance with the capital plan's general fund debt program. >> o*blg, thank you very much, mr. clerk, this item was sponsored by supervisor tang, so we'll turn it over to her. >> thank you very much and i do see our director for animal care and control here, i want to thank them and everyone else who has been supportive throughout the years trying to get our new animal shelter here in san francisco rebuilt. i know our previous conversation was about dilapidated city facilities and certainly the acc building is one of those, which has fallen off of not just one but two bond measures now which is the

only reason why i brought forth this resolution which is before us today to amend our ten year capital plan to include this facility as part of the city's certificate of participation program instead of the previous public health bond measure, so i think that at this point, i'm going the turn it over to the capital planning staff as well as our director don hew from acc and see if colleagues have any other questions, and i know that i think supervisor wiener has some comments as well. >> thank you, mr. chair, if i may. >> supervisor? >> first of all, i want to thank supervisor tang for her leadership in bringing this resolution forward, it is sdsh i share supervisor tang's strong desire the see this project move forward and to make sure we have an animal shelter that is -- a facility that is really worthy of the priority that san francisco has for all

animals. we know that animal care and control is our safety net, animal agency in terms of our commitment to the humane treatment of animals, this is an agency that does not pick and choose what animals it cares for, it takes in whatever animal needs help, whether it's an abandoned or abused dog or cat, whether it is an animal found on the street, whether it is a pigeon that someone finds injured on the sidewalk, whether it is a hamster or a lizard or any other manner of animal, this agency is responsible for taking care of those animals, and we need to make sure that we are providing this agency with the resources that it needs and supervisor tang and i have worked closely over the years on operational budget appropriations, but also to make sure that the facility is going to be safe in an earthquake and meets all the needs of this agency, so i'm

very supportive of this measure and i want to thank supervisor tang for her leadership. >> supervisor kim? >> thank you, i just wanted to reiterate the same words as supervisor wiener. i was disappointed i think as other colleagues on the board in termser of the process of how this shelter was included and not included in the public health and safety bond that moved forward in june, but i'm glad we did find another option. i think that this is a very important building to rebuild and to make sure is safe for not just all the animals na we care for and the facilities but of course all the workers inside the building as well, so thank you, supervisor tang, for your leadership in making sure we found a path moving forward to rehabilitate the site. >> supervisor yee? >> thank you, i'll join the chorus, thank you, supervisor tang, for taking leade